Emerging Technologies in Healthcare: Challenges and ...

Emerging Technologies in

Healthcare: Challenges and

Opportunities

Carol Huston, MSN, MPA, DPA, FAAN

Professor Emerita, School of Nursing,

California State University Chico

Thank you for inviting me to

be here today!

Technology and the reform of

health care will continue to

bring both significant challenges

and opportunities in the future!

All nurses will be challenged

to develop the skillsets and

leadership behaviors they

need to address emerging

technologies.

Visioning: A Daunting Task

Demonstrating caring in an era of

technology driven healthcare can

be challenging…

Even the COVID-19

pandemic has accelerated technology

growth.

Source: Landi, H. (2020, Dec. 14). 7

predictions for what lies ahead for health

tech in 2021.Retrieved Jan. 14, 2021

from

https://www.fiercehealthcare.com/tech/7-

predictions-for-how-technology-will-

shape-healthcare-2021

Fisk (2019) notes that the 2020s will

be a decade of transformation. Indeed,

Fisk suggests there will be more

change in the next 10 years than the

last 250 years.

Technology has already changed our

lives dramatically!

What are some of the technologies that will

change the practice of healthcare?

What skill sets will nurses need to develop to

acquire, use, and integrate these emerging

technologies as health care reforms?

What new roles will emerge for nurses in this

new era?

Select Technologies

Reforming Healthcare

1. Genetics and genomics

2. Less invasive and more accurate tools for diagnosis and treatment

3. Robotics

4. Biometrics

5. Electronic health records

6. Computerized physician/provider order entry and clinical decision support

GENETICS AND GENOMICS

Precision Medicine

An emerging approach for disease

treatment and prevention that takes into

account individual variability in genes,

environment, and lifestyle for each person

Source: U.S. National Library

of Medicine (2020). What is

precision medicine? Retrieved

Jan. 13, 2021 from

https://ghr.nlm.nih.gov/primer/

precisionmedicine/definition

Carroll (n.d.) suggests the healthcare system

will transition from one which “fixes people

after they’re sick” to one of preventative,

diagnostic genomic-based medicine where

patients will be treated for conditions, we know

they are likely to develop.

Source: Carroll, J. (n.d.). It’s January 15, 2020.

What have we learned about healthcare in the last

decade? Retrieved Jan. 14, 2021 from

https://cdn.jimcarroll.com/wp-

content/uploads/2010/04/HealthCare2020.pdf

Gene therapy

will continue

to make

significant

inroads in

curing cancer

or preventing

birth defects.

Organ transplants

may no longer be

needed because

we’ll be able to

grow new organs

from a patient’s

own tissues.

Stem cells will be

used to generate

replacement

cartilage tissue to

repair damaged

joints, especially

for osteo-arthritis

patients.

We may be able to grow new

teeth instead of buying dentures.

Source: Jamilian, A. (2020, July 30). Growing teeth by using stem cells. Retrieved Jan. 14, 2021 from

https://jamilian.net/en/growing-teeth-by-using-stem-cells/

New Drugs To Treat Cancer…

LESS INVASIVE AND MORE

ACCURATE TOOLS FOR

DIAGNOSIS AND TREATMENT

Did any of you ever see Dr.

McCoy on Star Trek and

how he diagnosed patients?

Diagnostic body scans

will become part of showering!

Circulating nanobots will identify

and repair disease processes.

We’ll have blood

tests which will

detect potentially

harmful cardiac

artery blockages,

avoiding the more

risky angiograms.

Prescription Tattoos: Coming to

a Pharmacy Near You

We are likely to see the

increased use of magnets

to treat depression.

Deep Transcranial

Magnetic Stimulation

can perform non-

invasive yet deep

stimulation to the

brain, increasing

neurotransmitter levels

and possibly improving

the symptoms of brain

disorder.

Source: Brainsway. Deep TMS

therapy.(2021). How does it

work? Retrieved Jan. 13,

2021 from

http://www.brainsway.com/us

New scanning technology will

eliminate the need for exploratory

surgery and invasive procedures.

3-Dimensional (3D) Printing

Bioprinters, using a "bio-ink" made of

living cell mixtures can build a 3D

structure of cells, layer by layer, to

form human tissue and eventually

human organs for replacement.

Bionic Ears Created

Using 3D Printing

Researchers

3D Print

Prototype

For 'Bionic

Eye'

Source: Researchers 3D print prototype for bionic eye (2018, August 28).

Science Daily. Retrieved Jan. 14, 2021 from

https://www.sciencedaily.com/releases/2018/08/180828172043.htm

ROBOTICS

The Covid-19

pandemic accelerated

the development and

use of autonomous

robots that emit

germ killing

ultraviolet light

to decontaminate

rooms in 15

minutes…

Source: Joy, K. (2020, Dec. 22).

Healthcare tech trends for 2021: New

tools to watch. Retrieved Jan. 14, 2021

from

https://healthtechmagazine.net/article/2

020/12/healthcare-tech-trends-2021-

new-tools-watch

…and radio-frequency identification

(RFID) technology to track how long —

and how often — employees wash their

hands.

Source: Joy, K. (2020, Dec.

22). Healthcare tech trends

for 2021: New tools to

watch. Retrieved Jan. 14,

2021 from

https://healthtechmagazine.

net/article/2020/12/healthca

re-tech-trends-2021-new-

tools-watch

Biomechatronics

Merging

the human

with the

machine…

Robots in Surgery

Robots in Diagnostics and

TherapyThis is a robotic breast examiner!

Robots as Direct

Care Providers

Physical

Service

Robots

Robots as Mental Health

Care Providers

• Mental

service

robots

PARO

• A therapeutic

robot

• Retails for about

$6000

• 8 generations have

been produced

since 2003

After the

2011 Tsunami

in Japan…..

Huston (2017) suggests that the lack of

emotion in patient care robots is the

element of human caregiving that can never

be replaced. However, as technology

continues to advance, the ability to

distinguish robot from human caregiver is

declining.

Source: Huston, C. (2017). “Technology in

nursing: Emerging ethical dilemmas.” In

Ethical competence in nursing practice

edited by Catherine Robichaux. Springer

Publishing.

Kansei Robots

Could you have a

therapeutic

conversation with a

robot? Can patients?

Are the elderly and other vulnerable

populations at risk for deception?

Can these populations clearly

differentiate between man and

machine?

Do mental health robots improve or further the problem of social isolation in the elderly and other

vulnerable populations?

Highly refined

simulation will

increasingly be

used as an

adjunct to or

replacement of

clinical

learning

experiences.

BIOMETRICS

Biometrics

The science of

identifying people

through physical

characteristics---

fingerprint, handprint,

retinal scan, voice

recognition, and facial

structure

The use of handprints, retinal

scans, facial geometry and

dynamic signatures as

biometric signatures will

become commonplace.

Palm vein

scanning

as a

biometric

tool

Electronic Healthcare

Records

Source:

How much does EHR software

cost? (2021). CostOwl.com.

Retrieved Jan. 14, 2021 from

https://www.costowl.com/b2b/emr-

software-ehr-cost.html

• Multi-physician practices pay

between $180,000 and

$200,000 for their EHR

systems.

• First-year maintenance costs

average between $80,000 and

$100,000.

• Training costs between $2,000

and $3,000.

• System hardware averages

between $5,500 and $6,000.

• IT-related issues and support

average between $3,000 and

$4,000.

The 24-hospital Sutter Health in California paid out more than $1 billion for its EHR and the 38-

hospital Kaiser Permanente invested $4 billion for its system (McCann, 2015).

The 24-hospital Sutter Health in

California paid out more than US $1

billion for its EHR and the 38-

hospital Kaiser Permanente invested

US $4 billion for its system.

Sources: Arndt, R. Z. (2018, Oct. 18). For EHR Reporting

Program, cost transparency is top of mind. Retrieved Jan. 14,

2021 from

https://www.modernhealthcare.com/article/20181018/NEWS/18

1019884/for-ehr-reporting-program-cost-transparency-is-top-of-

mind

McCann, E. (2015, Sept. 11). 2015 EHR satisfaction survey.

Retrieved Jan.14, 2021 from

http://www.healthcareitnews.com/infographic/2015-ehr-

satisfaction-survey

The Challenges of EHRs

• Not easy to implement

• Expensive

• Lack of funding

• Debates about who

“owns” the data in the

system

• Getting computers to

“talk to each other”

Patients feel less satisfied if providers

focus on their computers instead of them

as it depersonalizes the encounter. In

addition, the patient’s medical record may

become “yes” or “no” data points.

Source: Robert Wood Johnson Foundation.

(2016). EHRs: Fundamentally changing

the nature of care. Charting Nursing’s

Future. Issue No. 29. Retrieved Jan. 14,

2021, from

https://www.rwjf.org/content/dam/farm/re

ports/issue_briefs/2016/rwjf433148

Computerized Physician/Provider

Order Entry And Clinical

Decision Support

A promising

technology that allows

providers to enter

orders into a computer

and to access the latest

information on best

practices

What is CPOE and

Why Do We Need It?

Clinical Decision Support (CDS)

Skill Sets Needed To

Respond To These Emerging

Technologies

Three Skill Sets Needed in an Era

of Technology Driven Healthcare

1. Being Able to Use Technology

to Facilitate Communication

and Relationships

2. Having Expertise in

Knowledge Information,

Acquisition, and Distribution

3. Understanding and Using

Genomics

Emerging Critical Skill Set:

Being Able to Use Technology

to Facilitate Communication,

and Relationships

Technology as a

Leadership

Competency

The ability to integrate

technology which facilitates

mobility and portability of

relationships, interactions,

and operational processes

Emerging Critical Skill Set:

Having Expertise in Knowledge

Information, Acquisition, and

Distribution

Knowledge information,

acquisition and distribution will

continue to multiply exponentially.

Source: How fast is knowledge doubling? (2021).

Lodestar Solutions. Retrieved Jan. 14, 2021 from

https://lodestarsolutions.com/keeping-up-with-the-surge-

of-information-and-human-knowledge/

In a profession where clinical knowledge doubles every 18 months, nurses can no

longer be the keeper of knowledge; instead they must become the master of collecting and learning new knowledge.

The Internet and

The Expert Patient

Source: eBiz. (2020, August). Top 15 best health websites.

Retrieved Jan. 14, 2021, from http://www.ebizmba.com/articles/health-websites

For example, Genetic testing can now prevent

disease, but it also creates a new set of moral,

legal, ethical, and policy issues:

• If the testing is useful, how do we provide equal access? What

are the potential privacy issues and how do we protect this

very personal and private information?

• Which genetic abnormalities warrant some kind of

intervention? How do we ensure that the information

provided by genome analysis is correct (especially in the case

of at-home tests)?

• Are we headed towards a new era of therapeutic intervention

to increase quality of life, or a new era of eugenics?

Source: John J. Reilly Center. (2018, para 2). Genetic testing & personalized medicine.

University of Notre Dame. Retrieved from http://reilly.nd.edu/outreach/emerging-ethical-

dilemmas-and-policy-issues-in-science-and-technology/personalized-medicine

Emerging Critical Skill Set:

Understanding and Using

Genomics in Practice

Healthcare providers must

know how to obtain family

histories, identify individuals

at risk, help people make

informed decisions about the

results of their

genetic/genomic tests and

therapies, and refer at-risk

people to appropriate health

care professionals and

agencies for specialized care.

Low cost genetic sequencing is now

readily available to all consumers..

Direct-to-consumer

genetic testing

companies have proven

particularly popular,

with more than 30

million people around

the world having taken

a DNA test as of 2020.

Source: Advisory Board (2020, Feb. 20). Has the consumer DNA test boom gone

bust? Retrieved Sept. 13, 2020 from https://www.advisory.com/daily-

briefing/2020/02/20/dna-tests

I’ve been genetically sequenced!!

But it’s not something that should

be taken lightly.

Many ethical questions exist

regarding whether relatives of

someone with a positive predictive

genetic test should or must be told

about the results.

Four Leadership

Challenges in

Integrating New

Technology

1. Balancing the human element with

technology

2. Balancing cost and benefits

3. Training a technology enabled workforce

and assuring ongoing competency

4. Assuring that technology use is ethical

Perhaps the

Greatest Challenge

for Healthcare

Leaders?

Balancing

Technology and the

Human Element

Nurses need to make sure the

human element is not lost in the

race to expand the use of

technology.

Ethical Considerations:

• Dignity/autonomy

• Technology as a potentially cold/

dehumanizing part of care

• Technology as a potential

contributor to disparities of care

• Nursing’s voice

What makes new technology worth the

cost? What criteria should be used in

making these potentially value-based

decisions? (Huston, 2022-In Press)

Is need driving technology or

is technology driving need?

We need to avoid being enticed

by technology for its own sake—

and be clear on the precise

problem the new technology is

designed to solve.

“Ethicists and health professionals alike are now raising questions about when and from

whom treatments should be withheld, as competition for the scarce medical resources of

the health care system grows beyond the system's capacity to provide care for everyone.

Already, some forms of rationing have been implemented, and more rationing of health

care resources may be inevitable” (Markkula Center, n.d. para 2).

“Ethicists and health

professionals alike are raising

questions about when and from

whom treatments should be

withheld, as competition for

scarce medical resources grows

beyond the system's capacity to

provide care for everyone.

Already, some forms of rationing

have been implemented, and

more rationing of health care

resources may be inevitable”

(Markkula Center, n.d. para 2).

Source: Markkula Center for

Applied Ethics. (n.d.).

Unhealthy dilemmas. Santa

Clara University. Retrieved

Jan. 14, 2021

from

http://www.scu.edu/ethics/pu

blications/iie/v3n3/homepage

.html

Since access to technology is often

dependent on a person’s ability to pay

for that technology, many health care

disparities still exist in this regard.

Should health care technology ever be

rationed by age? By ability to pay?

By perceived potential contributions

to society at large?

Other Challenges?

•Training

•Assuring Ongoing

Competency

•Implementation

Other Challenges?

•Ethical Considerations

Wadhwa (2014) suggests that with the pace of technology growth, we have not been

able to come to grips with what is ethical, let alone determine what laws or rules should

be in place.

Wadhwa (2014) suggests that with the pace of

technology growth, we have not been able to

come to grips with what is ethical, let alone

determine what laws or rules should be in place.

Source: Wadhwa, V. (2014, April 15).Laws and ethics can’t keep pace with technology

codes we live by, laws we follow, and computers that move too fast to care. Retrieved Jan. 14,

2021 from https://www.technologyreview.com/s/526401/laws-and-ethics-cant-keep-pace-with-

technology/

“We need to step back before we adopt

new technology and have a conversation

about how this will impact care. What do

we lose by adding this technology? What

will we gain? Nurses on the front lines of

care 24/7 are the people to figure this

out.”—

Source: Carol Huston, as quoted by Robert Wood Johnson Foundation. (2016, para 8).

Nursing’s role in guiding technological change. Charting Nursing’s Future. Issue No.

29. Retrieved Jan. 14, 2021, from

https://www.rwjf.org/content/dam/farm/reports/issue_briefs/2016/rwjf433148

nurses must increasingly speak up and ask “how” and “why” technology should be

implemented.

Nurses must increasingly speak

up and ask “how” and “why”

technology should be

implemented.

New or Expanded Roles for

Nurses in an Era of Technology

and Healthcare Reform??

• Nurse Navigators

• Nurse

Informaticists

• Nurse Ethicists

• Nurse Geneticists or Nurses with

Significant Genetic Expertise

• Nurse Policy Leaders

• Nurse Change Agents

“The expectation in healthcare is that a leader

is able to deliver new things, sometimes not

even knowing what they were yesterday, and

deploy those technologies in an excellent way.” ----Russell Branzell, president and CEO of the College of Healthcare

Information Management Executives

Source: Joy, K. (2020, Dec. 22).

Healthcare tech trends for 2021:

New tools to watch. Retrieved

Jan. 14, 2021 from

https://healthtechmagazine.net/a

rticle/2020/12/healthcare-tech-

trends-2021-new-tools-watch

Huston (2014) notes that evolving technologies offer great opportunities to improve the quality of

patient care, but technology alone is not the answer. Regardless of the system that is deployed,

health care organizations must consider what technology can best be used in each individual setting

and how it should be used ethically. In addition, successfully adopting and integrating new

technology requires care providers to understand that technology’s limitations as well as its

benefits.

Evolving technologies offer great

opportunities to improve the quality of life,

but technology alone is not the answer. We

must consider, however, what technology is

best in each setting and how it should be

used ethically. In addition, every care

provider must understand

every technology’s

limitations as well as

its benefits.

Questions? Comments?

Thoughts?